Yoo Yeun Jie, Kim Jae Won, Kim Joon Sung, Hong Bo Young, Lee Kyoung Bo, Lim Seong Hoon
Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Front Neurol. 2019 Apr 15;10:374. doi: 10.3389/fneur.2019.00374. eCollection 2019.
The restoration of hand function is an important goal for patients with stroke. This study investigated the relationship between corticospinal tract (CST) integrity and the functional status of the hand in patients with stroke 6 months after onset and evaluated which of the following values would be useful for predicting hand function: fiber number (FN), fractional anisotropy (FA) at the mid-pons, and FA at the pontomedullary junction. The present retrospective cross-sectional observational study assessed 44 patients with stroke who were able to walk without using a walking aid or orthosis. The final hand function results were classified into three groups: no recovery (unable to grasp), partial recovery (able to grasp, unable to oppose), and full recovery (able to grasp and oppose). All subjects underwent diffusion tensor imaging (DTI) at 6 months after stroke onset. Values for FA at the mid-pons and pontomedullary junction and CST FN were measured. The normalization ratio for FN and FA was calculated using the following formula: data for affected hand/data for non-affected hand. The normalized FN, FA (mid-pons), and FA (pontomedullary junction) DTI values differed significantly. The FA (mid-pons) value for the full recovery group was higher than those for the other groups. The FA (mid-pons) value for the partial recovery group was higher than that for the no recovery group. The normalized FA (mid-pons) value differed significantly among all three groups. The present study showed that CST integrity (at 6 months after onset) in patients with chronic stroke was related to functional hand status. In addition, the mid-pons FA value was more predictive of functional restoration of the hand than the FN or FA value at the pontomedullary junction. These results may be useful in predicting the functional restoration of the hand and understanding the functional prognosis of stroke.
恢复手部功能是中风患者的一个重要目标。本研究调查了中风发病6个月后患者的皮质脊髓束（CST）完整性与手部功能状态之间的关系，并评估了以下哪些值有助于预测手部功能：纤维数量（FN）、脑桥中部的分数各向异性（FA）以及脑桥延髓交界处的FA。本项回顾性横断面观察研究评估了44例能够在不使用助行器或矫形器的情况下行走的中风患者。最终的手部功能结果分为三组：无恢复（无法抓握）、部分恢复（能够抓握，无法对指）和完全恢复（能够抓握并对指）。所有受试者在中风发病6个月后均接受了弥散张量成像（DTI）检查。测量了脑桥中部和脑桥延髓交界处的FA值以及CST FN。FN和FA的标准化比率使用以下公式计算：患侧手部数据/健侧手部数据。标准化后的FN、FA（脑桥中部）和FA（脑桥延髓交界处）DTI值存在显著差异。完全恢复组的FA（脑桥中部）值高于其他组。部分恢复组的FA（脑桥中部）值高于无恢复组。三组之间标准化后的FA（脑桥中部）值存在显著差异。本研究表明，慢性中风患者（发病6个月时）的CST完整性与手部功能状态相关。此外，与脑桥延髓交界处的FN或FA值相比，脑桥中部的FA值对手部功能恢复的预测性更强。这些结果可能有助于预测手部功能恢复情况并了解中风的功能预后。
